<div class="form_container" style="width: 760px;">		 
	<table cellpadding="0" cellspacing="0" width="500px">
		<tr>
			<td class="label">{translate}Full name{/translate}</td>
			<td class="field">{$name}</td>
			<td class="label">{translate}Patient's ID{/translate}</td>
			<td class="field" style="text-align: left;">{$code}</td>
		</tr>
		<tr>
			<td class="label">{translate}Address{/translate}</td>
			<td colspan="3" class="field">{$address}</td>
		</tr>		
		<tr>
			<td colspan="4">
				<input id="turn_back" class="button_link" type="button" value="{translate}Back{/translate}" onclick="javascript:turnBack('multi_payment_content', 'ticket_content')">
			</td>
		</tr>	
	</table>
</div>

<table id="payment_details" class="grid" cellspacing="0" cellpadding="0">
	<thead>
	<tr>
		<th class="first">{translate}Order number{/translate}</th>													
		<th>{translate}Day{/translate}</th>		
		<th>{translate}Real payment{/translate}</th>
		<th class="last">{translate}Cashier{/translate}</th>				
	</tr>
	</thead>
	<tbody>
	{foreach from=$result item=item}	
	<tr>
		<td class="first">{$item.count}</td>		
		<td><a href="javascript:viewDetails({$item.payment_collection_id}, '', 1, '');">{$item.date}</a></td>
		<td style="text-align: right;">{$item.amount}</td>
		<td class="last" style="text-align: right;">{$item.cashier}</td>
	</tr>	
	{/foreach}
	</tbody>
</table>